16 February 2008

I spent the day at the Sacramento Veteran’s Administration Medical Center yesterday, specifically in the “UrgiCare” department, which is the VA’s version of an emergency room.

Mr. Wren had felt quite unwell, with a fluttery heart sensation, nausea, vomiting and dizziness after eating a gigantic supper the night before. His blood pressure was fluctuating and in the north of normal range (he has a BP cuff prescribed by his VA doc and uses it daily). Were his symptoms indicative of major indigestion or heart problems?

We called the VA health nurse, who handles questions about how to deal with situations like this. Mr. Wren takes heart medication for (the relatively common) atrial fibrillation, along with a lot of other meds that treat everything from osteoarthritis pain to depression. He’d just started a new med for tension/migraine headaches. Could an adverse drug interaction be causing these symptoms? Should we treat them as potentially life-threatening? Or should we chill and wait it out?

As Mr. Wren answered the nurse’s many questions (the nurse was very thorough and with a calm, competent demeanor), he started feeling better. They decided he should stay home and get some rest, and the following day, call his regular doc’s office at the medical center and tell them that the health nurse said he should get a same-day appointment. It would be smart, the nurse said, to have a check-up.

And so, yesterday morning, still feeling fine and (by now) a little sheepish, Mr. Wren called for the appointment and was told they’d call him back with a time. And while we waited, he started feeling bad again. Same symptoms, though he didn’t vomit this time. Two hours passed and we still hadn’t heard from his doctor’s office about an appointment, so we called again. This time we were told we should just get our butts to UrgiCare.

So we made the 41-mile drive down the mountain to the VA medical center, which is at the old Mather AFB, long closed and now a civilian industrial park and commercial airport.

They took him in immediately upon learning of the fluttery sensation and did an EKG. It was normal, thank goodness. No emergency. So he was sent back out to chairs to wait his turn while the doctors dealt with patients who needed their immediate attention more urgently than Mr. Wren.

We waited. And waited. And waited. For two hours we endured back-to-back Gerry Springer shows on the big screen TV that hangs from the ceiling in the waiting area. It cannot be ignored because the volume is quite loud to accommodate the many, many elderly, hard-of-hearing vets who come for care at the center. Anticipating a lengthy wait and knowing I’d find little to read in the waiting area except for really old copies of Time magazine or new copies of The Watchtower, I’d brought along Sinclair Lewis’s “It Can’t Happen Here,” a book I’ve been wanting to read for a while now. But I couldn't concentrate on it. First, I was concerned about Mr. Wren, who wasn’t feeling very well even if he wasn’t considered an emergency. Second, Lewis’ style is a bit dense and flowery, written in another era. It takes some effort to get used to it and “fall in” -- an effort that kept being undermined by the bare-knuckled, “spontaneous” male fistfights and subsequent whiny girlfriends on Springer. These dragged my attention away from the book, piquing the same base but natural, morbid curiosity that makes us rubberneck at serious car accidents. It annoyed me but I couldn’t help it. Also, the TV audience was constantly chanting "Ger-REE, Ger-REE, Ger-REE ..." Honestly, sometimes I'm embarrassed for us.

At hour four, my eyes crossing with boredom, I went outside to call our daughter and let her know her Dad was still alive, feeling blech and still waiting to be seen. That done, I went back inside. Mr. Wren was gone. They’d finally called him in. I was very relieved.

I settled back into my chair and tried once again to read. Impossible. This time it was Oprah. I noticed that she’s gaining weight again. She’s up and down, I thought cattily, big and little, over and over, year after year. Her personal chefs and trainers get richer each time she yo-yos because they write books about how they helped her achieve little and beautiful again, and how we can all do it too if we buy their books and follow instructions. There’s a whole shelf at the bookstore groaning with capital-O cookbooks and how-to-lose-weight guides.

Now, the moment these mean and unsolicitous thoughts passed through my head, I felt bad for thinking them. I know how hard it is to lose weight, get fit and maintain both. Who am I to criticize poor Oprah? She can’t manage to stay skinny even with personal chefs and trainers, absolutely a testimony for how truly tough it is. If she can’t do it with expensive experts feeding her perfectly balanced, low fat, low carb, low calory and yet still delicious and satisfying meals and snacks, and then forcing her to exercise two hours a day, every day, then I shouldn’t feel bad if I backslide now and then, right?

Then it occurred to me that maybe Oprah loses and gains weight on purpose so tubby people like me will be sure to watch her show and buy her products and those of the companies that advertise during her show. Watching her weight go up and down gives us a perfect opportunity to indulge our catty sides, then feel vindicated, then self-righteous, and finally really guilty for being so mean, which brings us full circle back to catty again as compensation for the guilt.

Meow.

Guilty as charged, I forced my eyes back to Lewis again and realized that I’d read the same paragraph three or four times now without noticing. My eyelids were very heavy, but I knew if I dozed off I'd drool all over my chest. Too embarrassing. It's times like this that I really miss smoking. At least puffing a cigarette outside while shivering coatless in the cool, late winter afternoon would wake me up and give me something to do.

I looked at the clock. It had been an hour since Mr. Wren had disappeared. No one had come out to tell me he was in trouble, so I figured no news was good news. The VA is, after all, the epitome of universal health care and a close cousin to military health care, which is good, competent, and slow as molasses unless you’re seriously ill, injured or dying. So Mr. Wren, I figured, was probably stuck back there waiting for a doctor yet again. At least he was there and not out here. The cogs would creak and groan and eventually spit him back out to me.

Throughout the wait, I’d been people-watching. The VA medical center is a good place for it. Like the ex-military members it serves, the VA is made up of people representing the American melting pot. It’s America from sea to shining sea, concentrated and condensed. In the same waiting room there were blacks, whites, Asians, Hispanics, men and women, young and old, speaking a variety of languages and in a variety of accents and dialects. I always loved that about the military. I still do. As much as I like where I live these days, the homogenous nature of the population – 98.9 percent white – bothers me after my years spent either in the military or working with military members and their families. So being at the VA med center and fitting right back into the mix was both familiar and comforting.

The UrgiCare clinic has to be the gimpy-est place I’ve ever seen, though. There were all kinds of people walking on crutches or with canes, or using walkers of various descriptions, or just limping along in obvious discomfort. Everyone there seemed resigned, like we were, to the long wait. There was one young woman, holding a green velvet cape tightly wrapped around her, who was so sick she just curled silently in her chair, staring blank-eyed into the middle distance while her very large girlfriend patted her shoulder gently. There were a few very elderly men in wheelchairs, tended by family members. They had once stood tall and straight, you could tell. They still had that military bearing, if not health and youth. A woman came in pushing her husband before her in a wheelchair. She looked to be in her late 50s or perhaps very early 60s, stylish, brisk, and competent. He didn’t look much older than she was, but he was rigid in his chair, one arm twisted to his chest, his head tilted a bit to the side, his eyes wide and his face frozen in a permanent expression of astonishment. He had been – still was – a handsome fellow. Was he a stroke victim? Perhaps the victim of a traumatic brain injury? She signed him in, then went about making him as comfortable as she could, talking to him softly, stroking the close-cropped hair at the back of his neck as she helped him drink water from a squeeze bottle. Her devotion – and sorrow – were poignant.

Another hour passed. I finally decided I had to know what was going on with Mr. Wren. I headed for the triage nurse’s station, and as I did, he came out the automatic sliding doors from the emergency clinic’s inner sanctum. He had blood-spotted cotton balls stuck to his inner elbows and a bemused look on his face.

Turns out they’d laid him down, put an IV in his arm and, telling him he was dehydrated, gave him fluids and an anti-nausea medication. That done, they checked him again and sent him on his way. He emerged feeling much better and hungry as a horse.

And so we drove home. There was no diagnosis, but he's back to normal. He still needs to get in and see his doctor about that new medication to make sure it wasn’t what brought on the heart flutters. Maybe he just ate too much and his body rebelled? Hard to say, but we had a good reminder of what we’ll be in for if and when this country gets universal health care. Waiting is part of the price we’ll all pay. But I think it’s worth it, in the end. That treatment at a regular emergency clinic would have cost us hundreds if not thousands of dollars. I haven’t got health insurance right now, myself, so I dread the idea of getting sick. But Mr. Wren was treated at absolutely no cost to us since he’s a disabled, Viet Nam-era veteran who gave many years of his life to his country. I’m thankful for that, and glad that a portion of my taxes goes to pay for his care, and for the care of all the others who need it, especially the new, very young, disabled vets that are coming out of Iraq and Afghanistan. The VA isn’t perfect, that’s for sure. But as a model of what universal healthcare could be like, it’s worth a good look.

3 comments:

...knowing I’d find little to read in the waiting area except for ... new copies of The Watchtower

{shudder}

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This was really a great piece, but, for the life o' me, I can't decide in which magazine I could imagine reading it!

I too would much prefer SLOW but SURE Health Care to the hodge-podge of overpriced BS I've experienced in the last 10 years or so. Hekk! My lady friend just lost her job, but turned down her boss's offer to pay for her Insurance for 3 months as part of her severance because she Knows from experience that Medicaid is better coverage.

I like your style. I happened upon your blog when I was looking for an RN position I came across last week...I couldn't find it, but maybe for the best. You have inspired me to write more. It's great therapy!